Lecture 22: The Body Measured, Graphed, and "Instrumentalized" Monday, April 13, 2009 2:24 PM Introduction: Standardization in Modern Medical Practice Thermometry: An Early Case of Standardization Ludwig Traube (1818-1876) & the therapeutic effects of digitalis One of the first people to want to determine specific temperatures Runs series of clinical experiments to determine clinical and physiological effect of digitalis In small doses, digitalis raises blood pressure & rate of heartbeat Also lowers body temperature (maybe…) In higher doses, digitalis appears to suppress heartbeat & blood pressure (opposite effect) Carl August Wunderlich (1815-1877) & fever as a graphical phenomenon Believes that medicine is too webbed to ancient medicine Medicine must explicitly base itself off of laboratory science Kymograph Produces Temperature/Pulse Chart (1860s) Looking at the pattern of temperature in a fever New Hospital-Based Technologies in the20th Century Blood counting Measurements of Blood Differential leucocytes count Ratio of polynuclear/mononuclear white blood cells Determined by visual inspection Measure of resistance to infection Hematocrit Ratio of red cells to total serum volume Measured by centrifuging cells Hemoglobin Determined by measuring color against standardized scale Chemical analysis of urine Color and specific gravity Etc. X-rays Wilhelm Conrad Rontgen (1845-1923) Completely new discovery, 1895(?) Within months, pictures taken with x-rays began popping up everywhere! X-rays could be useful in assessing fractures and more Their actual implication became much more slowly An experienced practitioner can actually feel what's going on, can diagnose a multiple fracture in the arm just by feeling it Surgeons already knew how to do this, thought x-rays were not that valuable Later, surgeons felt things should be examined by x-rays Advantages: the picture becomes objective evidence in the hands of the court system

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